Precocious puberty caused by an estrogen and androgen secreting adrenal adenoma: A case report and review of the current literature

A recent study by Herman-Giddens has documented that the onset of puberty in normal girls is occurring at a younger age than in past generations. The normal range for clinical signs of puberty is now accepted to begin at 7 years in Caucasian girls and 6 years in African-American girls [1]. This discovery has prompted new recommendations regarding which girls with early signs of puberty to evaluate. In addition, the failure of LHRH analogue therapy to impact on adult height in girls between 6 to 8 years with central precocious puberty as compared to younger girls has reinforced the idea that puberty in this age group is a benign condition [2]. In most girls, precocious pubertal development is gonadotropin-dependent, due to early release of normal central nervous system suppression of the hypothalamus. Ninety-five percent of the time this is "idiopathic" rather than due to CNS abnormalities like tumors, infection or trauma. Uncommonly, early pubertal signs occur due to abnormal gonadotropin-independent production of estrogen or androgen from the ovary or adrenal gland. We present the case of a 6-year-old girl with an unusual adrenal tumor which produced both androgens and estrogens, thus mimicking central precocious puberty.